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IMCI-REVIEWER-Prelims.pdf Flashcards
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What is IMCI?
IMCI is an integrated approach to child health that focuses on the well-being of the whole child, aiming to reduce death, illness, and disability, and promote improved growth and development among children under five years of age.
When did WHO and UNICEF start to develop the IMCI strategy?
WHO and UNICEF started to develop the IMCI strategy in 1992.
What are the factors of poor health mentioned in the text?
Factors of poor health mentioned include poor access to health facilities, lack of access to education, food insecurity, and lack of basic resources like clean water and sanitary toilets.
What is the benefit of Integrated Case Management (IMCI)?
IMCI helps in identifying health issues that may not have been identified otherwise, and it enables rapid and affordable interventions to be provided.
What does IMCI focus on improving?
IMCI focuses on improving case management skills of health care providers, overall health systems, and family and community health practices.
What are some barriers to accessing education for families in developing countries?
Poor roads, high transportation costs, lack of basic resources like clean water and sanitation, food insecurity, and limited access to education for the mother.
What is the benefit of Integrated Case Management (IMCI)?
IMCI helps identify health issues that may have gone unnoticed, provides rapid and affordable interventions, improves the skills of care providers, and enhances the management of childhood illnesses.
What are some key points about IMCI guidelines?
Assessing all young infants and children for common causes of illness and death, using charts to classify problems and guide treatment, and improving care provider skills, knowledge, and adherence to national health guidelines.
What is the purpose of the IMCI case management process?
To improve case management and counseling skills, knowledge of national health guidelines, facilities and health systems for managing childhood illnesses, as well as family and community practices in home treatment and disease prevention.
What are the components of the IMCI Chart Booklet and Recording Forms?
The IMCI Chart Booklet includes sections for recording notes on the IMCI process and critical health information about the child, with separate sections for sick children and sick young infants following the same order as the IMCI recording form.
What steps are involved in the IMCI case management process?
Follow national health guidelines, manage childhood illness, practice family and community practices, provide home treatment, prevent disease, and minimize health risks around the home.
What is the purpose of the Chart Booklet and Recording Forms in IMCI case management?
To record notes on the IMCI process and critical health information about the child, and to help assess, classify, identify treatment, and treat the child.
How are the charts in the Chart Booklet ordered?
They follow the same order as the IMCI recording form, with sections for a sick child and a sick young infant based on the child's age.
What are the two important points about the recording forms in IMCI case management?
There are separate recording forms for a sick child and a sick young infant, and a second recording form is used for follow-up visits.
What does the ASSESS AND CLASSIFY chart in IMCI case management describe?
It describes how to assess the child, classify the child's illnesses, and identify treatments based on the assessment column on the left side of the chart.
What are two important points about recording forms in the given text?
a) There are separate recording forms for the sick child and one for the sick young infant. b) A second recording form is used when the child or infant returns for a follow-up visit.
What does the ASSESS AND CLASSIFY chart describe and how is it used?
It describes how to assess the child, classify the child's illnesses, and identify treatments. The ASSESS column guides taking a history and performing a physical examination, noting symptoms and signs. The CLASSIFY column lists clinical signs and their classifications, with decisions made on the severity of the illness and treatments identified in the TREATMENT column.
How is the treatment information recorded in the recording form according to the text?
The treatments identified for each classification are written in the TREATMENT column on the reverse side of the recording form. When a child has multiple classifications, treatments for each classification are recorded.
What is the purpose of the IMCI chart titled TREAT THE CHILD as mentioned in the text?
The IMCI chart instructs on how to administer the identified treatments, either in the clinic or through teaching.
What should be written in the CLASSIFY column of the recording form for each symptom of the illness?
The classification selected for each symptom
What information is shown in the TREATMENT column of the ASSESS AND CLASSIFY chart?
The recommended treatment for each classification
Where should the treatments identified for each classification be written on the recording form?
On the reverse side of the recording form
What should be recorded when a child has more than one classification of illness?
Treatments for each classification should be recorded
What information does the IMCI chart titled TREAT THE CHILD provide?
Instructions on how to give the identified treatments in the clinic or at home, including medicines, doses, and timing of administration
What does the COUNSEL THE CAREGIVER chart include recommendations on?
Feeding, fluids, home treatment, and when to return to the clinic
Where should the results of any feeding assessment be recorded?
At the bottom of the case recording form
What information should be recorded on the reverse side of the case recording form regarding follow-up care?
The earliest date for the child to return for follow-up
During a sick child visit, what should the healthcare provider listen for regarding the caregiver?
Any problems the caregiver may be having that require treatment or referral for her own health problems
What should be advised to the caregiver if she is experiencing health problems during the sick child visit?
She should be advised to seek treatment or referral for her own health problems
When should you counsel all caregivers about certain topics if a child is going home from the clinic?
Before the child goes home from the clinic.
IMCI-REVIEWER-Prelims.pdf Flashcards
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Why is good communication with a caregiver important?
1. Good communication helps to reassure the caregiver that her child will receive good care. 2. When treating the child's illness, you will need to teach and advise the caregiver about caring for the sick child at home, which requires good communication and trust from the beginning of the visit.
What are the components of good communication skills with a caregiver?
A. LISTEN: Listen carefully to what the caregiver tells you. B. SIMPLIFY WORDS: Use words the caregiver understands to ensure clear communication. C. GIVE HER TIME: Allow the caregiver time to answer questions and make decisions. D. BE CLEAR: Ask additional questions when needed to clarify the caregiver's answers. E. PRAISE: Praise the caregiver for providing information and being involved in the child's care.
How can you ensure that the caregiver understands the questions you ask?
Use words the caregiver understands
Why is it important to give the caregiver time to answer questions?
So she can provide the information needed to assess and classify the child correctly
What should you do if the caregiver is not sure about her answer to a question?
Ask additional questions to clarify
Why is it important to praise the caregiver during the assessment process?
To reinforce good practices
What important information should you gather during a greeting with the caregiver?
A) Age for determining which IMCI charts to use B) Child's problem/symptoms C) Weight and temperature
What information should the healthcare provider gather from the caregiver about the symptoms or health problems of the child?
Duration of symptoms, progression, and previous care given
Why is it important to check the child's weight and temperature during the assessment?
To assess the child's health status and monitor changes during the evaluation process
When should the child's weight and temperature be recorded, and how should the child be handled during this process?
Weight and temperature should be recorded later, without disturbing or undressing the child during the initial assessment
How can the healthcare provider distinguish between an initial visit and a follow-up visit for a child's health problem?
An initial visit is the child's first for the current illness episode, while a follow-up visit is when the child was seen previously for the same issue a few days ago
What are the key aspects of making contact and communication between the healthcare provider and the caregiver during a healthcare assessment?
Posturing at the same level, maintaining eye contact, and removing physical barriers for effective communication
What is the difference between an initial visit and a follow-up visit for a child's episode of illness?
An initial visit is the child's first visit for the episode of illness, while a follow-up visit is when the child was seen a few days ago for the same problem.
What are the key elements of making contact with the mother during a health visit?
Ensuring that the health worker and mother's heads are at the same level, maintaining eye contact, and removing any barriers between them like tables or notes.
What are the general danger signs to look out for in a child during a health visit?
1. Child is not able to drink or breastfeed 2. Child vomits everything 3. Child has had more than one convulsion or prolonged convulsions or is convulsing 4. Child is lethargic or unconscious
How can a health worker check for a general danger sign in a child?
By asking three questions and observing the child's actions: 1. Ask 'Is your child able to drink or breastfeed?' 2. Look for signs of the child's actions 3. Open the Chart Booklet to the chart for general danger signs
What are the four steps involved in assessing for general danger signs in a child?
Ask three questions and look to observe the child's actions.
When assessing if a child is able to drink or breastfeed, what signs indicate that the child is not able to suck or swallow?
The child is not able to suck or swallow when offered a drink or breast milk.
What should you do if a caregiver mentions that their child is not able to drink or breastfeed?
Ask the caregiver to describe what happens when they offer the child something to drink and observe if the child can swallow the fluid.
What should be done if a child who is breastfed has difficulty sucking when their nose is blocked?
Clear the child's nose, and if they can breastfeed after the nose is cleared, they do not have the danger sign of not being able to drink or breastfeed.
What does it mean if a child vomits everything and is not able to hold anything down at all?
The child has the danger sign of vomiting everything, where everything that goes down comes back up.
What should you look for to see if a child is swallowing water or breast milk?
Check to see if the child is swallowing the water or breast milk.
What is a possible difficulty a breastfed child may have if their nose is blocked?
Difficulty sucking when the nose is blocked.
What should you do if a child's nose is blocked?
Clear the child's nose if it is blocked.
If a child can breastfeed after the nose is cleared, does the child have the danger sign of not being able to drink or breastfeed?
No, the child does not have the danger sign if they can breastfeed after the nose is cleared.
What is the danger sign related to a child who vomits everything they consume?
The danger sign is that the child vomits everything they consume, where everything that goes down comes back up.
What does it indicate if a child is not able to hold anything down at all?
The child has the danger sign of vomiting everything they consume.
If a child vomits several times but can hold down some fluids, do they have the danger sign of vomiting everything?
No, they do not have the danger sign if they can hold down some fluids.
How should you ask about convulsions in a child?
Ask the caregiver if the child has had more than one convulsion or prolonged convulsions during the current illness.
What physical signs may indicate a child is having a convulsion?
During a convulsion, the child's arms and legs stiffen because the muscles are contracting.
IMCI-REVIEWER-Prelims.pdf Flashcards
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What should the caregiver do if the child's body is bent at the waist and it is hard to see the lower chest wall move?
Ask the caregiver to change the child's position so he is lying flat in her lap.
What are the three possible classifications for a child with cough or difficult breathing?
1. Severe pneumonia or very severe disease 2. Pneumonia 3. Cough or cold
What action should be taken if a pulse oximeter is available and the oxygen saturation is below 90?
Refer the child for further evaluation and management.
What treatment can be used for a child with fast breathing but no chest indrawing in low HIV settings?
Oral Amoxicillin for 3 days.
What should be done for a child classified as having severe pneumonia or very severe disease?
Urgently refer the child to a hospital for treatments such as oxygen, bronchodilator, or injectable antibiotics.
What treatment can be tried for very severe pneumonia or very severe disease in a child?
Oral salbutamol may be tried.
What actions should be taken for a child classified as having severe pneumonia or very severe disease?
Urgent referral to a hospital for treatments such as oxygen, a bronchodilator, or injectable antibiotics. Give the first dose of an appropriate antibiotic before the child leaves.
How should a child with pneumonia be treated?
Treatment with oral amoxicillin for 5 days. Begin treatment in the clinic and continue at home.
What additional treatment may be required for a child with wheezing?
Treatment with an inhaled bronchodilator.
What actions should be taken for a child classified as having cough or cold?
Provide appropriate treatment based on the absence of general danger signs, chest indrawing, stridor, or fast breathing.
What treatment is required for a child with wheezing?
Treatment with an inhaled bronchodilator is required for a child with wheezing.
What action should be taken for a child who is HIV exposed or infected and has chest indrawing?
The caregiver should give the first dose of amoxicillin and refer the child to the hospital.
What is the classification for a child with cough or difficult breathing but none of the general danger signs?
A child with cough or difficult breathing but none of the general danger signs is classified as COUGH OR COLD.
Does a child with COUGH OR COLD require an antibiotic?
No, a child with COUGH OR COLD does not need an antibiotic as it will not relieve the child's symptoms or prevent the cold from developing into pneumonia.
What should be done for a child with a chronic cough lasting more than 2 weeks?
A child with a chronic cough lasting more than 2 weeks should be referred to the hospital for further assessment.
What are the three pieces of critical information identified in the classification table for treating a child with cough or difficult breathing?
1. Appropriate treatment for each classification 2. Where treatment is given (clinic, home, or second-level facility) 3. Pre-referral treatments are identified in bold and required
What are some potential causes of a chronic cough lasting more than 2 weeks in a child?
Tuberculosis, asthma, whooping cough, or another problem
When should a child with a chronic cough be referred to a hospital for further assessment?
If the child needs urgent referral or has severe symptoms
What three pieces of critical information are identified in the classification table for treating a child with cough or difficult breathing?
1. Appropriate treatment for each classification 2. Where treatment is given (clinic, at home) 3. Pre-referral treatments needed for urgent referral
What are the three treatments identified for cough or difficult breathing in children?
1. Oral antibiotics like amoxicillin 2. Remedy for soothing sore throats 3. Inhaler treatment if wheezing
What are the general instructions for giving oral antibiotics to a child with cough or difficult breathing?
Review instructions for giving antibiotics with integrated management, follow guidelines for various classifications requiring antibiotics, such as pneumonia, severe pneumonia, severe dehydration, and dysentery
How should you give oral antibiotics according to the provided instructions?
Give the first line oral antibiotic if available, followed by the second line if the first line is not available or if the child's illness does not respond to it. If the child can drink, give an oral antibiotic that is appropriate for the specific illness.
What are the general instructions for giving antibiotics with integrated management?
The first time learning about antibiotic use within IMCI, review general instructions on giving antibiotics. Follow instructions in the section 'TREAT THE CHILD' for various classifications that require antibiotics listed in the instructions provided.
What illnesses are covered in the section for learning about antibiotics in the instructions provided?
Pneumonia, severe pneumonia, very severe disease, severe dehydration with cholera in the area, dysentery, very severe febrile disease, severe complicated measles, mastoiditis, and acute ear infection.
What should be done if the first line anbioc is not available or if the child's illness does not respond to the first line anbioc?
Give an oral antibiotic if the child is able to drink. The appropriate oral antibiotic for each illness varies by country.
What should be done if the chart identifies more than one illness requiring antibiotics?
If one antibiotic can treat multiple illnesses, use that antibiotic. If multiple antibiotics are needed, give each antibiotic based on the specific illnesses.
How should a child with dysentery and acute ear infection be treated with antibiotics?
They can be treated with a single antibiotic, such as co-trimoxazole, if it is the first or second line antibiotic for both dysentery and acute ear infection.
What caution should be taken when treating a child with more than one illness requiring the same antibiotic?
Do not double the size of each dose or give the antibiotic for a longer period of time. Follow the dosage and schedule indicated on the TREAT THE CHILD chart.
What should be done if more than one antibiotic is required to treat multiple health problems in a child?
Give each antibiotic separately based on the illnesses. Follow the dosage and schedule provided on the TREAT THE CHILD chart.
How should the appropriate dosage of antibiotics be decided when treating a child?
Refer to the TREAT THE CHILD chart for the schedule and dose of giving antibiotics. The schedule indicates how many days and how many times each day to administer the antibiotic.
IMCI-REVIEWER-Prelims.pdf Flashcards
Study
What should you examine about the infant's movements in the ASSESS chart for a sick young infant?
Additional detail about the infant's movements.
What is persistent diarrhea defined as?
Diarrhea that lasts 14 days or more.
What should you ask the mother in regards to the duration of diarrhea in a sick child?
Ask how long the diarrhea has been present.
What is dysentery and what is its most common cause?
Dysentery is diarrhea with blood in the stool, and the most common cause is Shigella bacteria.
What is dehydration in young infants and why is it dangerous?
Dehydration is when a child loses too much water and salt, which can lead to serious problems and even death.
What is Oral Rehydration Salts (ORS) and how can it help in treating dehydration?
ORS is a mixture of glucose and salts that can help restore the balance of water and salt in the body to treat dehydration.
What type of ORS should be used to treat dehydration?
Low osmolarity ORS should be used to treat dehydration.
What is dehydration and how does it affect the body?
Dehydration is when the child loses too much water and salt from the body, causing a disturbance of electrolytes which can affect vital organs.
How can dehydration be treated?
A child who is dehydrated must be treated to help restore the balance of water and salt. Many cases of diarrhea can be treated with Oral Rehydration Salts (ORS), a mixture of glucose and several salts. Extra fluids can be used as home treatment to prevent dehydration.
What type of ORS should be used to treat dehydration?
Low osmolarity ORS should be used to treat dehydration.
What are some signs that help assess the severity of dehydration in a child?
Signs include the child being restless or irritable, sunken eyes, loss of skin elasticity, lethargy, or unconsciousness.
How can you assess dehydration based on the child's general condition?
Check for general danger signs like lethargy or unconsciousness. Restlessness and irritability can also be indicators of dehydration.
What are the general danger signs to check for in a child?
Lethargic or unconscious
How is a child classified as restless and irritable?
If they are restless and irritable all the time, even when touched or handled
What is a sign of dehydration to look for in a child?
Sunken eyes
How can you confirm if a child's eyes appear sunken due to dehydration?
Ask the mother if she thinks her child's eyes look unusual
What can cause a child to be unable to drink?
Lethargy, unconsciousness, inability to suck or swallow
What can a mother's opinion help confirm when it comes to a child's eyes looking unusual?
It can help confirm signs of dehydration in a severely malnourished child who may appear wasted.
How can you classify dehydration in a child based on how they drink?
Watch how the child drinks by offering water in a cup or spoon. A child who drinks eagerly and acts thirsty shows signs of good hydration.
What are signs that a child is not able to drink when offered water?
A child may not be able to drink if they cannot suck or swallow, are lethargic, unconscious, weak, or need help to drink.
How can you determine if a child is drinking eagerly and acts thirsty when offered water?
Look to see if the child reaches out for the cup or spoon, wants more water when it's taken away, and drinks without needing encouragement to continue drinking.
What is the purpose of the skin pinch test in assessing dehydration?
The skin pinch test helps assess dehydration by checking the skin's elasticity. Dehydrated children may have less elastic skin.
How can you determine if a child is thirsty and eager to drink water?
Offer the child a cup or spoon of water and observe if they reach out for it. Take the water away and see if the child is unhappy because they want to drink more. If the child only drinks with encouragement and does not want more, they are not thirsty or eager to drink.
What is the skin pinch test used for in assessing dehydration in children?
The skin pinch test is used to assess dehydration in children by checking the elasticity of the skin. Dehydrated skin loses elasticity, indicating dehydration.
How is the skin pinch test performed to assess dehydration in children?
1. Ask the mother to place the child flat on the examining table or on her lap. 2. Use thumb and first finger to locate the area halfway between the umbilicus and the side of the abdomen. 3. Pick up all layers of skin and tissue underneath. 4. Hold the skin pinch for one second, then release. 5. Observe how quickly the skin pinch goes back: very slowly (>2 seconds), slowly (<2 seconds), but not immediately, or immediately.
What is the purpose of the skin pinch test described in the text?
To assess dehydration in children by checking how quickly the skin returns to normal after being pinched.
Where on the child's abdomen is the area located for performing the skin pinch test?
Halfway between the umbilicus and the side of the abdomen.
How long should you hold the pinch of skin during the skin pinch test?
For one second.
What should you observe after releasing the skin pinch during the test?
Observe how quickly the skin goes back to its normal position.
Is the skin pinch test always an accurate sign of dehydration? Why or why not?
No, it is not always accurate. In cases of severe malnutrition, the skin may go back slowly even if the child is not dehydrated. In overweight or edematous children, the skin may go back immediately even if dehydration is present.
IMCI-REVIEWER-Prelims.pdf Flashcards
Study
How should the caregiver give extra fluid when diarrhea starts?
Tell the mother to continue breastfeeding with the addition of ORS and clean water. If the child is exclusively breastfed, breastfeed more frequently than usual. Breastfed children under 4 months should be breastfed first, then given ORS. If the child is not breastfed, give ORS solution, food-based fluids, soup, rice water, yogurt drinks, and clean water.
What steps are involved in mixing Oral Rehydration Solution (ORS)?
a) Wash hands with soap and water b) Pour all the powder from one packet into a clean container c) Measure 1 liter of clean water or the correct amount for the packet used d) Pour the water into the container and mix well until the powder is dissolved e) Taste the solution to know how it tastes
What is step a in preparing ORS solution at home?
Wash your hands with soap and water
What is step b in preparing ORS solution at home?
Pour all the powder from one packet into a clean container. Use any available container such as a jar, bowl, or bole.
What is step c in preparing ORS solution at home?
Measure 1 litre of clean water or correct amount for packet used. It is best to boil and cool the water, but if this is not possible, use the cleanest drinking water available.
What is step d in preparing ORS solution at home?
Pour the water into the container. Mix well until the powder is completely dissolved.
What is step e in preparing ORS solution at home?
Taste the solution so you know how it tastes. The caregiver should mix fresh ORS every day in a clean container. She should keep the container covered. She should throw away any solution remaining from the day before.
How much fluid should be given in addition to the usual fluid intake for children up to 2 years after each loose stool when using ORS?
50-100 ml
How much fluid should be given in addition to the usual fluid intake for children 2 years or older after each loose stool when using ORS?
100-200 ml
What are the instructions for giving ORS to a child at home?
1. Give frequent small sips from a cup. 2. If a child vomits, wait 10 minutes. Then continue but more slowly. 3. Continue giving extra fluid until the diarrhea stops.
When is it especially important to give ORS at home according to the provided instructions?
When a child was treated with Plan B or C during this visit, in other words, the child has just been rehydrated.
How much additional fluid intake is recommended for children up to 2 years old after each loose stool?
50-100 ml
How much additional fluid intake is recommended for children 2 years or older after each loose stool?
100-200 ml
What are the caregiver instructions for giving ORS to a child?
1. Give frequent small sips from a cup. 2. If a child vomits, wait 10 minutes then continue but more slowly. 3. Continue giving extra fluid until the diarrhea stops.
Why is it important to give ORS at home after a child has been treated with Plan B or C during a visit?
To prevent dehydration from coming back.
When should zinc supplements be given to children with diarrhea?
Zinc supplements should be given to children 2 months up to 5 years old.
What is the purpose of giving zinc supplements to a child with diarrhea?
To reduce the duration and severity of the diarrheal episode, decrease stool output, and decrease the need for hospitalization.
At what age range is zinc treatment recommended for children with diarrhea?
Zinc treatment is recommended for children 2 months up to 5 years old.
What does Rule 3 'CONTINUE FEEDING' suggest to caregivers?
To continue feeding the child, following special feeding recommendations if the child has persistent diarrhea.
When should a caregiver return to a health worker immediately according to the information provided?
When specific signs indicate the need for immediate attention and intervention.
What is the recommended age range for giving zinc to children with diarrhea?
2 months up to 5 years
What are the signs that indicate a caregiver should return a child with diarrhea to a health worker immediately?
Not able to drink or breastfeed, becomes sicker, develops a fever, blood in stool, drinking poorly
How long should a child have persistent diarrhea before being referred to a hospital if signs of dehydration are present?
14 days or longer
What is the most important treatment for persistent diarrhea in children with no signs of dehydration?
Special feeding
What should you do if a child has persistent diarrhea for 14 days or longer and signs of dehydration?
Refer them to the hospital for special attention to prevent fluid loss and treat dehydration before referral.
What is the most important treatment for persistent diarrhea without signs of dehydration in children?
Special feeding, which may include more frequent and longer breastfeeding, fermented milk products, or nutrient-rich semi-solid foods.
What feeding recommendations should be followed for a child with persistent diarrhea?
Give small frequent meals at least 6 times a day, avoid very sweet foods or drinks, and follow age-appropriate feeding recommendations.
How long should a child with persistent diarrhea receive zinc supplementation?
For 14 days.
What treatment should a child with dysentery receive?
Ciprofloxacin for 3 days or another oral antibiotic recommended for Shigella in the area.
What feeding recommendation should be followed for the child?
Give small frequent meals at least 6 times a day and avoid very sweet foods or drinks.
